smmcac chair summaries feb. 10, 2021

Version #2 Updated February 10, 2020

Medicaid/CHIP Services

Advisory Committee Chair Summaries

February 10, 2021

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Updated February 10, 2020

Behavioral Health Advisory Committee (BHAC)

Updated January 2021

Committee Charge

The purpose of the committee is to provide customer/consumer and stakeholder input to the Health and Human Services

system in the form of recommendations regarding the allocation and adequacy of behavioral health services and

programs within the State of Texas. The BHAC considers and makes recommendations to the HHS Executive

Commissioner consistent with the committee’s purpose.

Recommendations to Health and Human Services system agencies regarding behavioral health services include:

● The promotion of cross-agency coordination, state/local and public/private partnerships in the funding and

delivery of behavioral health services;

● The promotion of data-driven decision-making;

● The prevention of behavioral health issues and the promotion of behavioral health wellness and recovery;

● The integration of mental health and substance use disorder services in prevention, intervention, treatment, and

recovery services and supports;

● The integration of behavioral health services and supports with physical health service delivery;

● Access to services and supports in urban, rural, and frontier areas of the state;

● Access to services and supports to special populations;

● Rules, policies, programs, initiatives, and grant proposals/awards for behavioral health services; and

● The five-year behavioral health strategic plan and coordinating expenditure plan.

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Issues of Importance

The Behavioral Health Advisory Committee (BHAC) has made recommendations on the following topics:

● Behavioral Health workforce shortages

● Expanded services for students in facilitates that provide substance use treatment

● Peer support services

● Family peer support services

● Youth peer recovery

● Housing

● Expansion of HCBS-AMH

● Recovery housing

● Boarding home reporting

● Trauma informed care for individuals with IDD

● First Episode Psychosis

Updates

The full BHAC met on October 9, 2020 and during that meeting the committee voted to formally approve two

recommendations authored by the newly founded “Peer and Family Partner Services” subcommittee. The

recommendations include:

● amending Medicaid rules to extend the same eligibility requirements to individuals under the age of 21 for peer

support services funded through Medicaid and

● expanding family peer support services to include Parent/Family Peer Support, provided by Certified Family

Partners, Certified Family Peer Support Providers or Certified Family Specialists, as determined by the state

certification entity as a covered service under the Medicaid State Plan to caregivers of children with serious

emotional disturbances.

● These recommendations were approved by the full committee and will continue to be tracked and monitored by

IDD-BHS leadership and staff.

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Additionally, the BHAC discussed goal setting and prioritization for the next fiscal year under new leadership. The

subcommittee structure was revised to reduce the total number of subcommittees to allow for focused, intentional, work

in areas of primary concern to the BHAC as the 87th legislative session approaches.

The new subcommittees of the BHAC are as follows:

● Peer Specialist & Family Partner Services

● Access to Care & Community Engagement

● Housing

● Policy & Rules

● Children & Youth Behavioral Health Services

● Mental Health & Substance Use Disorder Parity

Upcoming meeting: February 5, 2021

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Drug Utilization Review (DUR) Board


Committee Charge

The Drug Utilization Review (DUR) Board consists of physicians and pharmacists who provide services across the entire

population of Medicaid recipients and who represent different specialties, as well as nonvoting members who represent

the Medicaid managed care organizations (MCOs), and a consumer advocate representing people enrolled in the Medicaid

program. The members of the DUR Board are appointed by the Executive Commissioner and are reflective of the various

regions within Texas. The purpose of the DUR program is to improve the quality of pharmaceutical care by ensuring that

prescriptions are appropriate, medically necessary, and not likely to result in adverse medical outcomes.


Board members meet quarterly at the DUR Board meeting to make recommendations to the Medicaid Vendor Drug

Program (VDP) on the appropriate use of pharmaceuticals, including retrospective and prospective interventions.

Retrospective interventions include educational materials to providers to improve prescribing and dispensing practices

and effectively improve the quality of drug therapy. Prospective interventions include a clinical prior authorization

specific to a drug that is implemented in the claims processing system. The recommendations are based on a review of

clinical information from compendium and peer-reviewed medical literature with consideration of public comments or

testimony received at the meetings or submitted in writing to Health and Human Service Commission (HHSC). In

addition, members recommend drugs for inclusion in the Medicaid preferred drug list (PDL), considering the drug's

clinical efficacy, safety, cost-effectiveness, and program benefits.

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Updates

A summary of the Oct DUR board meetings and Jan 2021 meeting are now available from the Vendor Drug Program

website. This includes:

● A recording of this meeting’s webcast

● Approved minutes from the July 24, 2020, and October 22nd and 23rd 2020 meetings

● A summary of clinical prior authorization and preferred drug list recommendations

● The preferred drug list class review schedule for the next meeting

The next board meeting is scheduled for Friday, April 23, 2021. Meeting dates and instructions for submitting written

materials to the board and publicly testifying before the board are available on the Texas Vendor Drug Program website.

Welcomed two new members in Jan 2021 meeting: Joshua R. Johns, Pharm. D. (Richardson) and Sarah E. Kubes, Pharm. D.

(San Antonio)

Resources

https://www.txvendordrug.com/about/news/2020/11/october-2020-drug-utilization-review-board-meeting-summary

https://www.txvendordrug.com/about/news/2021/02/january-2021-drug-utilization-review-board-meeting-summary

Contact

[email protected]

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https://www.txvendordrug.com/about/news/2020/11/october-2020-drug-utilization-review-board-meeting-summary


https://www.txvendordrug.com/resources/drug-utilization-review-board/dur-board-meetings


mailto:[email protected]


e-Health Advisory Committee (eHAC)


Committee Charge

The committee advises the Executive Commissioner and Health and Human Services system agencies (HHS agencies) on

strategic planning, policy, rules, and services related to the use of health information technology, health information

exchange systems, telemedicine, telehealth, and home telemonitoring services.

EHAC advises HHS agencies on:

● development, implementation, and long-range plans for health care information technology and health information

exchange, including the use of:

electronic health records, computerized clinical support systems, health information exchange systems for

exchanging clinical and other types of health information, and

other methods of incorporating health information technology in pursuit of greater cost-effectiveness and

better patient outcomes in health care and population health.

● incentives for increasing health care provider adoption and usage of an electronic health record and health

information exchange systems;

● development, use, and long-range plans for telemedicine, telehealth, and home telemonitoring services, including

consultations, reimbursements, and new benefits for inclusion in Medicaid telemedicine, telehealth, and home

telemonitoring programs.

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● Telemedicine, Telehealth and Telemonitoring

● Disaster Response in Health Information Technology (HIT)

● Interoperability in Texas; standards and impact on data exchange and data accessibility

● Health Information Exchange (HIE) systems/mechanisms

● Practice of health information exchange and quality and accessibility of data exchanged

● Provider connectivity to HIEs; barriers to connectivity

● Patient Unified Lookup system for Emergencies (PULSE)

● Behavioral Health (new subcommittee created to address this topic)

Updates

● Seven membership terms expired in December 2020.

● New committee chair (George Gooch) and vice chair (Mari Robinson) selected in December 2020.Completed our

annual report which is available on the eHAC page of the HHS website

● Continued to discuss implementation of SB 670 (86th Legislature, Regular Session, 2019), HB 1063 (86th

Legislature, Regular Session, 2019), SB 922 (85th Legislature, 2017, Regular Session), and HB 1697 (85th

Legislature, Regular Session, 2017)/Rider 94 (86th Legislature, Regular Session, 2019) – Pediatric Telemedicine

grant program for rural Texas. Telemedicine and telehealth continue to be significant components of the

response to COVID-19. The HHSC Telemedicine, Telehealth and Telemonitoring Subcommittee has released their

2019 survey tool for providers with the goal of being able to perform a pre and post COVID-19 analysis of

provider’s attitudes and utilization of telemedicine and telehealth.

● Disaster Response in Health Information Technology (HIT)

● Interoperability in the U.S. – current status and future, including the final implementation of the “information

blocking” rule that was part of the 21st Century Cures Act, which significantly changes how organization share

patient data.

● Texas’ Health Information Technology strategic plan and DSRIP transition plan updates

● Health Information Exchange & accessibility to useable data

● Patient and provider identifier and efforts towards standardization

● Texas Immunization Registry, ImmTrac2: Bi-directional data exchange DSHS Health Reporting

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Hospital Payment Advisory Committee (HPAC)


Committee Charge

The Hospital Payment Advisory Committee (“HPAC”) is a subcommittee of the Medical Care Advisory Committee. HPAC

advises HHSC on hospital payment issues for Medicaid inpatient and outpatient services as well as advise HHSC on

supplemental payment programs/methodologies (e.g. Medicaid Disproportionate Share; Texas 1115 Waiver

Uncompensated Care payments; Texas 1115 Waiver Delivery System Reform Incentive Payment program; Uniform

Hospital Rate Increase Program; Graduate Medical Education, etc.).


• HHSC’s Delivery System Reform Incentive Payment (DSRIP) Program, which incentivizes hospitals and other providers to improve access to and delivery of care for Medicaid enrollees and low income uninsured individuals.

• Paying providers for uncompensated care (UC).

• Uniform Hospital Rate Increase Program (UHRIP), an endeavor that supports the hospital managed care reimbursement in the Texas STAR and STAR+PLUS programs.

• Supporting teaching hospitals which operate approved medical residency training programs. Medicaid GME payments recognize the higher cost incurred by teaching hospitals. Compared to non-teaching hospitals, teaching hospitals treat patients with more complex conditions and provide patient care that is more intensive and

technologically sophisticated. • Special payments to hospitals serving a disproportionately large number of Medicaid and low-income patients, or

disproportionate share hospitals (DSHs). • Rule on the interim State Payment Cap (formerly known as interim hospital specific limit).

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Updates

For the November HPAC meeting, the committee had one informational item – on the Uncompensated Care Secondary Reconciliation for demonstration years 6-8. Committee discussed this rule however since it was informational only, there was no vote on this rule. This meeting was used as a means for HPAC and HHSC to discuss other current topics of interest such as: Demonstration Year 10 UC Pool allocation; Private Hospital GME State Plan Amendment; ACA Medicaid DSH cuts; UHRIP reform; and a proposed Draft Monitoring Plan for Local Funding Sources.

Upcoming Meeting: February 4, 2021

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Intellectual and Developmental Disability (IDD) System Redesign

Advisory Committee (SRAC)

Updated October 2020

Committee Charge

Established in Chapter 534, Texas Government Code (SB 7, 83rd Texas Legislative Session), the committee is charged

with advising and collaborating with the Commission on the design of an acute care and long-term services and supports

(LTSS) system for persons with IDD under the Medicaid managed care program.

In fulfilling its charge, Chapter 534 specifies the goals of the redesign which, among other goals, must support improving

quality and outcomes for persons with IDD service, providing Medicaid services to more people in a cost-efficient manner

and improving access to services and supports.

Though the intent of Chapter 534 remains as codified via SB 7, 83rd Texas Legislature, several significant changes were

made to the law via HB 4533, 86th Texas Legislature. These changes include the following:

● In addition to the IDD SRAC, charged with advising and collaborating with the Commission in the redesign of the

system, HB 4533 established the STAR+PLUS Pilot Program Workgroup to assist in development of the pilot.

● The pilot program, which initially called for testing one or more service delivery models involving a managed care

strategy based on capitation to deliver long term services and supports under the Texas Medicaid program to

individuals with intellectual and developmental disabilities, now calls for a pilot program to test, through the

STAR+PLUS Medicaid managed care program, the delivery of long term services and supports to individuals with

an intellectual or developmental disability or cognitive disability and other individuals with disabilities who have

similar functional needs.

● Following evaluation of the pilot, the transition of long term services and supports provided through the

Intermediate Care Facilities (ICF/IID) program and the four Medicaid IDD waiver programs must now be done in

phases beginning September 1, 2027 and ending September 1, 2031.

● Prior to any transition of the residential services provided through the ICF/IID program and two of the four IDD

waiver programs, a separate pilot program must be conducted.

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In addition to advising the Commission on implementation of Chapter 534, issues of importance to the Committee

include development of or providing input into policies which: streamline and improve administrative processes under

managed care for providers, individuals and their families; ensure the managed care grievance process for individuals

and their families and providers is easy to access, provides timely resolution and tracks grievances by population and

topic to determine and resolve systemic issues; ensure that service coordination under the managed care program is

responsive to individuals’ needs; providing input into the Medicaid Waiver Interest List study required via Rider 42, HB 1,

86th Texas Legislative Session; promote network adequacy under the Medicaid managed care program and utilize

person-centered strategies and ensure ongoing communication and collaboration with other HHSC committees which

have similar interests in these and other topics related to improving the Texas Medicaid managed care program.

IDD SRAC Subcommittees

Three subcommittees assist the Committee in fulfilling its role and responsibilities. The subcommittees are: Transition

to Managed Care, Systems Adequacy and Day Habilitation & Employment Services.

Following passage of HB 4533 (86th R), the subcommittees, which used to meet every other month, now meet monthly

to fulfill their respective responsibilities.

The chart below lists topics the subcommittees are addressing.

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System Adequacy Transition to Managed

Care

Day Habilitation (DH) &

Employment Services

Shared and Specific Roles of

the Comprehensive LTSS

Providers, Local IDD Authorities

and Managed Care

Organizations under the Pilot

Pilot Eligibility Pilot Employment & Day

Habilitation (DH) Services

Pilot Regulatory Pilot Benefits Pilot Consumer Directed Services

Interest List Study – Rider 42,

86th Legislature

Pilot Dental HCBS Statewide Transition Plan

and Future of DH Services

Grievances/Complaints Pilot Housing Services Employment First & Person-

Centered Practices

IDD SRAC Work Activities

Though IDD SRAC and subcommittee work activities were halted following COVID-19, in May subcommittee activities

resumed. Between June and November, the IDD SRAC met monthly, as did two of the three IDD SRAC subcommittees,

to fulfill responsibilities related to development of recommendations for the pilot program.

Beginning January 2021, the IDD SRAC and subcommittees will resume their pre-COVID meeting schedule and meet

quarterly.

Note: While the work of the IDD SRAC and its subcommittees was halted between March and mid-May, HHSC worked

on the attached timeline for completing activities key to implementation of the STAR+PLUS Pilot Program. This timeline

will be helpful to the IDD SRAC as well as the STAR+PLUS Pilot Program Workgroup in fulfilling their respective charges

under Chapter 534, Texas Government Code. In reviewing the timeline, it is important to note that it reflects

preliminary HHSC estimates of implementation timeframes which will be refined through further discussions with

internal and external stakeholders.

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Though not included in this update, HHSC has also developed a communication plan for the IDD SRAC, the Pilot Program

Workgroup and HHSC which outlines the processes for reviewing and approving recommendations and reporting back on

the status of the recommendations.

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Medical Care Advisory Committee (MCAC)


Committee Charge

The MCAC assists HHSC in its efforts to provide cost-effective, high quality health care to Texans receiving Medicaid

services. The purpose of the Committee is to advise HHSC and specifically the State Medicaid Director regarding medical

care services and policies governing the administration of Texas Medicaid through its review of and recommendations on

Medicaid rules.

Our primary task is to review and discuss draft Medicaid rules and determine if they should be recommended for

publication in the Texas Register.


The Committee’s most serious concerns are for Medicaid rules impacting accessibility and quality of care. These include,

but are not limited to:

● Program eligibility

● Access to care

● Health care, including mental health parity

● Home and community-based services (HCBS)

● Provider compensation

Other issues of importance to MCAC include network adequacy, HCBS waivers, legislative and budget updates, Local

Provider Participation Fund Reporting and the Delivery System Reform Incentive Payment (DSRIP) Program.

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Updates

The last MCAC meeting was held virtually on November 12, 2020. The committee reviewed the following rules:

● Intellectual and Developmental Disability habilitative specialized services

● Medicaid Substance Use Disorder

● Federally Qualified Health Care Services Reimbursement

● Uncompensated care Secondary Reconciliation for Demonstration Years 6-8

● Rate Increase Attestation Process COVID 19

The committee voted to move the first two rules forward with the stipulation that HHSC meet with community

stakeholders for additional feedback.


We anticipate considering the following rules:

A. Nurse Aide Training and Competency Evaluation Program

B. Nursing Facility Administrator Licensing

C. Preadmission Screening and Resident Review (PASRR) Habilitation Coordination on Rule Review

D. STAR Health Continuity of Care

E. Behavioral Health Services Disaster Rules

F. Physician Directed Payment Program

G. Rural Health Clinic DPP

H. Community Mental Health Center DPP

I. Uniform Hospital Rate Increase Program Reforms

J. Ambulance Service Providers

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Palliative Care Interdisciplinary Advisory Council (PCIAC)


Committee Charge

The PCIAC assesses the availability of patient-centered and family-focused interdisciplinary-team-based palliative care in

Texas for patients and families facing serious illness. The Council works to ensure that relevant, comprehensive, and

accurate information and education about palliative care, including complex symptom management, care planning, and

coordination needed to address the physical, emotional, social, and spiritual suffering associated with serious illness is

available to the public, health care providers, and health care facilities.


Current issues of importance include raising awareness about supportive palliative care and hospice care services in

Texas; developing evidence to support coverage for supportive palliative care, including by Medicaid; improving services

and supports for family caregivers; and improving education and awareness of new palliative care developments and

trainings.

Upcoming Work

1. Provides professional and stakeholder input for the state’s Palliative Care Information and Awareness program

2. Consults with HHSC on a pilot study as per the mandate from Senate Bill 916 to assess potential improvements of

SPC on health quality, health outcomes, and cost savings from the availability of SPC services in Medicaid

3. In the process of creating workgroups to research and discuss current and ongoing issues in the field of palliative

care which may be developed into recommendations for the 2022 legislative report

4. In the process of developing the 2021 Advancing Palliative Care in Texas continuing education event being hosted

on November 5th, 2021 from 1 to 4pm

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Perinatal Advisory Council


Committee Charge

The Perinatal Advisory Council (PAC), established in 2013 by HB 15 of the, 83rd Texas Legislature (Regular Session) is

charged with providing clinical and non-clinical recommendations to DSHS for inclusion into their required rule template.

This has been done for both Neonatal and Maternal levels of care.


With the rules now in place, the PAC will focus on best practices and trends in neonatal and maternal results post

implementation of the new hospital designation programs.

Upcoming Work

● Provided feedback to the Maternal Mortality and Morbidity Review Committee (MMMRC) on recommendations to

reduce pregnancy-related death and maternal mortality that will be part of the MMMRC bi annual report.

● Met on September 15th and November 17th to continue discussions on SB 749 issues, and heard from

stakeholders regarding suggested rule language changes to hospital designation program.

● Prepared and submitted a letter to DSHS that summarizes PAC recommendations to consider for potential changes

to Hospital Designation levels of care rules as follows:

Telemedicine recommendations specific to levels of care for maternal and neonatal care.

Rather than revising the rules on gestational age, the PAC recommends developing a statewide database with

granular de-identified patient-based information in order to make further recommendations.

In the state’s deliberations on the appropriateness of a requested waiver, the PAC recommends considering

that We must maintain quality in the care of our Texas mothers and babies, while allowing for appropriate

access to high quality care.

The PAC recommends that DSHS defines the appeals process and allows for transparency of the process by

including this detail posted on their website.

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https://hhs.texas.gov/about-hhs/leadership/advisory-committees/perinatal-advisory-council


Rather than stating a time that has no known foundation in evidence-based medicine, we recommend the

wording be revised to reflect that pediatric echocardiography with pediatric cardiology interpretation and

consultation be completed within a time period consistent with current standards of professional practice

(mirrors the wording in other sections of the rules).

The PAC recommends revising the maternal rules to allow for any adult resuscitation course provided by a

nationally accredited organization.

The PAC also made recommendations on the need to have improved consistency regarding board certification

of members of the maternal care team at each designated level of care.

Upcoming Meeting: TBD February 2021

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Policy Council for Children and Families (PCCF)


Committee Charge

The PCCF works to improve the coordination, quality, efficiency, and outcomes of services provided to children with

disabilities and their families through the state's health, education, and human services systems. The purpose of the

Council is to advise the Texas Health and Human Services Commission (HHSC) on matters as described below:

A. Improving coordination between the state's health, education, and human services systems to ensure that children

with disabilities and their families have access to high quality services.

B. Improving long-term services and supports, including community-based supports for children with special health and

mental health care needs, as well as children with disabilities and their families receiving protective services from the

state.

C. Addressing emerging issues affecting the quality and availability of services available to children with disabilities and

their families.

D. Aligning resources with the service needs of children with disabilities and their families.

E. Improving the STAR Kids managed care program.

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Policy Council for Children and Families legislative report is submitted in November 2020 covering following

recommendations:

1. Supporting and expanding transition care clinics across Texas; 2. Increasing the threshold allowance for Medicaid Buy-in for Children and Adults to 300 percent of federal poverty

level; 3. Reducing the Medicaid waiver interest lists;

4. Ensuring access to Promoting Independence waiver slots; 5. Expanding crisis intervention and respite services;

6. Improving crisis intervention, respite, and early childhood intervention services; and 7. Strengthening disaster and emergency preparedness planning to ensure continued access to vital services during

natural disasters, pandemics or other large-scale events affecting children with disabilities and complex medical

needs.

Upcoming Work

Council members are looking for other issues which are potential topic for recommendations for next report. Some of the

issues include:

1. Looking into timely extension of MDCP date during pandemic.

2. Looking into timely receiving of prior authorization for service and medication, to continue providing service during pandemic.

3. Reviewing accessibility issue identified during new construction, especially schools, under Texas Architectural

Barrier Law. 4. Looking into work of Got Transition towards transitioning children to adult healthcare system and working towards

achieving the same outcome in Texas. 5. Identifying issues, the schools and students are experiencing during pandemic


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STAR Kids Managed Care Advisory Committee


Committee Charge

The STAR Kids Managed Care Advisory Committee was established by Senate Bill 7, 83rd Texas Legislature,

Regular Session, 2013 and in compliance with Texas Government Code Section 533.00254 to advise the Texas

Health and Human Services Commission (HHSC) on the establishment and implementation of the STAR Kids managed care program.

Members of the committee include a variety of stakeholders including families of children with disabilities receiving

services under STAR Kids, physicians, home health providers, managed care organizations (MCO), school personnel and

organizations representing children with disabilities. The diversity of the committee lends a unique perspective on how

the program is functioning across Texas and generates ideas and recommendations for improvements.


The committee currently has three subcommittees each tasked with developing recommendations aimed at improving

the program for children and families.

● Health Homes and Quality Measures

● Screening and Assessment Instrument (SK-SAI), Prior Authorizations, Medically Dependent Children Program

(MDCP), and Intellectual and Developmental Disabilities (IDD) Waivers

● Transition from Pediatric System to Adult System

Updates

1. The committee met on December 9, 2020 and discussed the following topics:

a. COVID update including flexibilities through the end of the Public Health Emergency b. Legislatively required changes including waiver interest lists, Coordination of Benefits, the STAR Kids

Screening and Assessment Instrument and the development of a hotline for the Medically Dependent

Children Program and the Deaf Blind with Multiple Disabilities waiver

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c. Durable Medical Equipment pilot d. eHealth Advisory Committee Telehealth recommendations

e. Draft recommendations made by each of the three subcommittees f. Presentation on Health Care Transition and Value-Based Payment models by the National Alliance to

Advance Adolescent Health

2. The committee met on January 6, 2021 and voted on a set of recommendations to include in our report to the Executive Commissioner and to the Legislature

3. The subcommittee on health homes and quality measures continues to work with HHSC on the development of updated quality measures as well as upcoming ACE Kids Act opportunities. The group is working with the Texas Collaborative Improvement and Innovation Network’s (CoIIN) initiative to improve outcomes for children with

medical fragility through the development of comprehensive health homes. The CoIIN is a project of the Health Resources and Services Administration. The subcommittee is also working on a pilot proposal to streamline

authorizations and assessments through improved health homes and coordinated multidisciplinary telehealth visits done at a child’s six-month visit.

4. The subcommittee on SK-SAI has worked with HHSC on optimization and changes to the tool. The subcommittee

identified families to participate in a dry run of the new tool and also provided feedback to HHSC on a survey to be administered by HHSC to families and MCO assessors following the testing of the revised tool. The subcommittee

also developed recommendations regarding lifting out-of-network benchmark limitations set on MCOs who deliver services for children in the MDCP waiver and will be providing written comments to HHSC following the release of the draft coordination of benefits language. The subcommittee also made recommendations for a broad definition

of specialty providers as required by SB 1207. 5. The subcommittee on transition has been working with HHSC and the National Alliance to Advance Adolescent

Health to explore a pilot to promote quality healthcare transition planning for young adults and improvements to the smooth transition of children from STAR Kids to STAR Plus in addition to making recommendations about increased training for transition specialists and services coordinators on transition, addition of transition specialists

to STAR Plus home and community-based waiver, improved Health Care Transition standards, updated billing codes for transition and standardized transition plan that can be used across MCOs.

6. The committee continues to have representatives on various SMMCAC subcommittees.

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STAR+PLUS Pilot Program Workgroup (SP3W)


Committee Charge

Established in Texas Government Code, Section 534.1015 (HB4533 of the 86th Regular Legislative Session), to advise the

Texas Health and Human Services Commission (HHSC) on the development, operation and evaluation of a new

STAR+PLUS Pilot Program. The pilot will be designed in consultation and collaboration with both the STAR+PLUS Pilot

Program Workgroup and the Intellectual and Developmental Disability System Redesign Advisory Committee (SRAC).

The Pilot will operate in the STAR+PLUS Medicaid managed care program and test the managed care delivery of long-

term services and supports (LTSS) for people with intellectual and developmental disabilities (IDD), traumatic brain

injury that occurred after age 21, or people with similar functional needs as a person with IDD. The pilot must start by

September 1, 2023, go for at least 24 months, and include an evaluation.

The evaluation will include wide-ranging information on the results of the pilot as well as other aspects of the IDD

System Redesign. The information gained through the pilot will also be used to inform the future transition Medicaid IDD

services into managed care.


● The Quality Subcommittee will address the following topics: Person-Centered Practices, Measurable Goals, and

Performance Measures.

● The Assessment Subcommittee will address the following topics: 1115 Waiver Requirements, Researching the

InterRAI or other assessments, and Potential Screening Tools relating to Eligibility.

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Updates

The full STAR+PLUS Pilot Workgroup met on December 16, 2020 with a packed agenda.

Dr. Julie Parsons presented the findings from the STAR+PLUS Pilot Program Dental Study as required by HB 4533 (86R).

The study evaluated dental service benefits in both Medicaid waiver programs and the Medicaid managed care model. It

then determined which benefits are the most cost-effective in reducing emergency room and inpatient hospital visits.

The study was then used to inform the dental service benefit to be provided in the STAR+PLUS pilot.

The following recommendations for benefits to include in the pilot were adopted by SP3W. These recommendations were

previously voted on favorably by IDD System Redesign Advisory Committee (SRAC) who then presented them to SP3W

for edits and/or adoption.

● - Program functions and responsible entities;

● - Dental service;

● - Adaptive aids and medical supplies;

● - Adult foster care;

● - Assisted living facilities;

● - Minor home modifications;

● - Protective supervision; and

● - Meaningful day and individualized support

In addition, both subcommittees presented their purpose and goals to the full committee and solidified their work plans.

Upcoming meeting: February 11, 2021.

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State Medicaid Managed Care Advisory Committee (SMMCAC)


Committee Charge

Provides recommendations and ongoing input to HHSC on the statewide implementation and operation of Medicaid

managed care. Areas of focus are shown in the 4 subcommittees below.


● Complaints, Appeals, and Fair Hearings - effectively leveraging complaints data to identify potential problems in

the Medicaid program, opportunities for improved managed care organization (MCO) contract oversight and

increasing program transparency. Objectives addressed in this initiative include:

Improve data collection and system processes used to trend and analyze managed care member complaints.

Standardize complaint categories used by HHSC and MCOs for more accurate trending of complaints-related

data to more quickly identify potential problems within managed care.

Improve the complaints member experience so they are tracked and resolved consistently.

● Network Adequacy and Access to Care - supporting a comprehensive monitoring strategy to ensure members have

timely access to the services they need. Objectives addressed include:

Improve the accuracy of provider directories, including more robust MCO validation requirements and

improvement of critical processes that impact accuracy.

Incentivize the use of telemedicine, telehealth, and telemonitoring services to improve access for members in

underserved areas of the state.

Reduce administrative burdens related to network adequacy reporting and monitoring.

Integrate network adequacy reporting to include additional measures, such as appointment availability studies

and targeted encounter data.

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● Clinical Oversight and Administrative Simplification - seeks to strengthen the oversight of utilization management

practices to include prior authorization policies and processes used by manage care organizations (MCOs).

Objectives addressed in this initiative include:

Reduce Medicaid provider burden through administrative improvements in four areas: claims payments,

eligibility information, provider enrollment processes and prior authorization submissions.

Prior authorization discussions will focus on provider process issues and Health and Human Services

Commission oversight of MCO prior authorization data.

Discuss specific Medicaid medical benefits as needed.

● Service and Care Coordination - improvements in service and care coordination within managed care. Objectives

addressed in this initiative include:

Analyze other state Medicaid programs to assess best practices for care coordination within Texas’ managed

care programs.

Address any state-level barriers that hinder MCO delivery of care coordination services.

Clarify terminology and definitions of service coordination and service management activities across Medicaid

managed care programs.

Identify possible improvements to ensure service coordination and service management is consistent within

HHSC contract requirements.

Updates

The SMMCAC and its subcommittees will meet on February 24 and 25. The meetings will be based on the new

subcommittee structure which combined the Clinical Oversight & Benefits and Administrative Simplification

subcommittees into one subcommittee. This will also be the first set of meetings for newly appointed member to the

SMMCAC. The committee is addressing topics such as:

● Overview of HHSC 2022-2023 budget request and exceptional items relating to Medicaid Managed Care

● Status of Intellectual and Developmental Disability Managed Care Pilot design progress and timeline

● Status of implementing portions of SB1207 from the 86th session that impact Medicaid Managed Care

● Highlights of good and poor performance of Medicaid Managed Care in order to identify potential areas where

strategies for improvement need to occur.


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Texas Council on Consumer Direction


Committee Charge

The Texas Council on Consumer Direction (TCCD) advises HHSC on the development, implementation, expansion, and

delivery of long-term services and supports through the Consumer Directed Services (CDS) option. The Council is

composed of CDS employers, representatives from Financial Management Service Agencies (FMSAs), representatives

from managed care organizations (MCOs) and advocates for children and older adults using the CDS option.

TCCD is established in accordance with Texas Government Code § 531.012 and governed by Texas Administrative Code

§ 351.817 and Texas Government Code Chapter 2110.


● Electronic Visit Verification (EVV): EVV is a computer-based system that will replace paper-based attendant

timesheets for Medicaid personal care services. EVV has been optional for individuals using the CDS option, but

became required beginning January 1, 2021 in accordance with the federal 21st Century Cures Act.

● Increasing the percentage of individuals receiving Medicaid long-term services and supports who use the CDS

option, including through efforts to increase and improve educational resources.

● Service authorization delays and short-term service authorization extensions in managed care programs, which

cause challenges with CDS budgeting and billing for EVV-required services.

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Upcoming Work

TCCD subcommittees met for the first time in 2020 in December to reassess goals and identify future projects, including:

● Quality Assessment and Performance Improvement Subcommittee:

Best Practices Guidelines for FMSAs

Oversight of Financial Management Services Agencies (FMSAs) in Medicaid managed care programs

● Process & Expansion Subcommittee:

Expanding the CDS option to additional program services

● Training & Outreach Subcommittee:

Revising and updating informational/educational materials about the CDS option, such as:

CDS employer manual

MCO service coordinator manual

The full Council and its subcommittees will meet in March 2021.

New Member Solicitation

• New member solicitation is in progress. The application for new members was posted on Jan. 21, 2021, and applications are due by 11:59pm on Feb. 14, 2021.

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https://hhs.texas.gov/sites/default/files/documents/about-hhs/news-articles/adv-comm/tccd-application-letter-jan-2021.pdf


Value-Based Payment and Quality Improvement Advisory

Committee (VBPQIAC)


Committee Charge

The Value-Based Payment and Quality Improvement Advisory Committee (“Committee”) was established by the

Executive Commissioner of the Health and Human Services (HHS) system to provide a forum to promote public-private,

multi-stakeholder collaboration in support of quality improvement and value-based payment initiatives for Medicaid,

other publicly funded health services, and the wider health care system. Committee members representing diverse

sectors of the healthcare system are tasked with providing input on quality improvement initiatives. By December 1 of

each even-numbered year, the committee submits a written report to the executive commissioner and Texas Legislature

with recommendations to help Texas achieve the highest value for healthcare in the nation.


● Expanding the use and effectiveness of alternative payment models (APMs) in the Medicaid program.

● Promoting the sustainability of Delivery System Reform Incentive Payment (DSRIP) initiatives showing the

greatest promise for improving value and quality in healthcare.

● Maximizing federal and other grant dollars available to support the development of evidence and implementation

of innovative care and payment approaches, including population and episode-based models.

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Updates

Legislative report submitted in December 2020, which includes following recommendations:

1. Maternal and newborn health

Standardize performance measures.

Establish a statewide de-identified registry linking mothers and babies.

2. Social determinants of health

Landscape assessment of SDOH assessment and referral platforms to determine best approach(es) for Texas

Medicaid.

Explore how to address SDOH through APMs, including ICD-10 Z codes, accountability metrics related to

SDOH/health equity, and pilots.

3. Leverage multi-payer data

Continue to encourage cross-agency collaboration in the use of healthcare data building on Special Provision

10.06 from the FY 20-21 budget.

Continue to work to better leverage the Texas Healthcare Learning Collaborative portal (and other tools as

appropriate) to increase and improve the data available to health plans, providers, and policy makers for core

metrics, analytics, and care coordination to support value-based purchasing and quality improvement.

4. Advance alternative payment models

Conduct a landscape assessment to determine the barriers and opportunities to advancing APMs. Convene

stakeholders to share the results of the assessment along with promising practices.

Leverage learnings from DSRIP to identify key outcomes and effective interventions.

Encourage MCOs to adjust APM requirements for providers in light of COVID.

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5. Lessons learned from COVID-19

Evaluate which Medicaid telehealth waivers put in place during the public health emergency should continue.

Incentivize creative practices that improve health based on the experience during COVID-19, such as

prospective payments for primary care providers.

Align VBP measures and incentives as much as possible within each region of Texas to reduce provider

administrative burden.

The report has been finalized and will soon be distributed to external stakeholders and HHSC staff.

Upcoming Work and Meetings:

Continuing workgroup calls to continue initiative in following area:

1. Continuing initiative to increase Value-Based Payment for Home Health and Community Pharmacy. 2. Continuing to explore lessons learned from COVID-19 (which includes Telehealth, Telemedicine, Health

Information Exchange, and paying differently for primary care). 3. Continuing to address the impact pandemic has on Behavioral Health.

4. Continuing to identify the ways to incentivize and evaluate Value-Based Payment interventions that address social factors.

5. Upcoming full council meeting is on Feb 3rd, 2021.

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smmcac chair summaries feb. 10, 2021

Documents